Provider Demographics
NPI:1578606844
Name:KHALILZADEH, TOURAJ (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:TOURAJ
Middle Name:
Last Name:KHALILZADEH
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 LICK AVE
Mailing Address - Street 2:#223
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3248
Mailing Address - Country:US
Mailing Address - Phone:443-527-6884
Mailing Address - Fax:
Practice Address - Street 1:1981 N BROADWAY
Practice Address - Street 2:SUITE 180
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3852
Practice Address - Country:US
Practice Address - Phone:925-478-4583
Practice Address - Fax:925-357-3899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1219451223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery